OVC Provider Forum Transcript

Sustainability of Victim Assistance Programs
Jenifer Markowitz  -  2009/9/30
Looking for input n how to sustain LE advocacy programs with very limited volunteer response and limited resources
 LE Law Enforcement Based Victim Advocacy Program
2.  HSternstein
 what is an le advocacy program?
3.  Jen Markowitz
 Thanks for your question. If you would be willing to check back on the site, I'd like to consult with a couple colleagues who have more experience with agencies such as yours and get back to you with a response. I hope I will have something for you by end of week, if that will work.
Do you have any information on implementing a step down process for VOCA Victims Assistance subgrantees? For example, full funding for one year, then 75% funding for the second year, then 50% funding
1.  Jen Markowitz
 This is also a question I have put out to colleagues in the field. I am actually working on finding you a specific resource working with VOCA subgrantees who could provide an answer for you. As with the previous question, please check back--I hope I can get information to you by the end of this week.
Good Afternoon Dr.Markowitz, This is asked on behalf of my Victimology & Victim Services class at Becker College... Where can Victim Assistance Programs obtain funding in todays economy, and if funds aren't available or run out, where do victims then go for assistance? Thank you, Professor Woods
1.  suzanne mazoff
 Our Rape Crisis Center just received a DVD, A Body of Evidence from the NYS Division of Criminal Justice. It is a step by step of the Sexual DOffense Evidence Collection Kit (aka rape kit). Perhaps your law enforcement agency for your state can help with the needs of advocates?
2.  Jen Markowitz
 Over at CalCASA's site, they posted a link earlier this year to an online seminar TechSoup did: Beginners: Getting Started with Social Media Tools. You can listen to the entire seminar and follow along with the corresponding PowerPoints by going to https://cc.readytalk.com/cc/schedule/display.do?udc=1uymcjoyix96g. That's probably a terrific place to start. In terms of using social media as a fundraising tool, consider checking out Developing a Social Media Plan (requires free registration to download) http://spurspectives.com/social-media-guide, and the slides from this spring's Social Media as a Fundraising Tool webinar available on SlideShare http://www.slideshare.net/edaconsulting/social-media-as-a-fundraising-tool-webinar-training-5609. There are also several blogs that focus on the topic, including Beth's Blog: How Nonprofits Can Use Social Media (my fave): http://beth.typepad.com/beths_blog. Sites like this will give you ongoing updates in a form that's easy to digest since the posts are usually pretty short.
3.  M. Ferraro
 I would really appreciate more information on social media, we are expanding our outreach this way and I am finding that there is a lot of tutorial information but it is piece mail. It would be nice to have a resource for victims services programs to learn to navigate and create social media pages.
4.  Jen Markowitz
 It's a great question. Funding in this economic climate is challenging for sure. I think there is a greater need for collaborative funding, rather than single agency funding, wherever possible. Using things like social media to raise awareness and funds is a fantastic option for many. I will come back to the forum after we're done and post a few links on using social media for fundraising if it's of interest to people. Where do people go when the funds run out? In my experience, they go to faith-based institutions, they come into our ERs and free clinics. Unfortunately, sometimes they don't go anywhere for assistance, and that's a huge challenge for us.
What advice do you have for communities without SANE's or a SART looking to develop services in their communities?
1.  Jen Markowitz
 Don't reinvent the wheel, first and foremost. Look to colleagues in other communities and many of the national TA providers for tools to ease and focus the process. NSVRC has some great tools available for instance: head over to http://www.nsvrc.org/projects/sart to see all the SART resources and sign up for the national SART listserv if that's of interest. IAFN's SAFETA project is another great resource: www.safeta.org. Peruse the site's form library and training info, or email Kim Day the project coordinator with specific questions--she's a walking encyclopedia of all things related to the National Protocol for Medical-Forensic Exams.
2.  Victoria
 This is exactly what I did in our small (25k+) community. We had nothing. A chance meeting with a local fire captain illuminated the need so, off I went to fulfill it. I started by interviewing neighboring areas who have crisis groups then built ours accordingly. Many established groups stepped up to provide our training, resources, at al. Unfortunately, the other areas are all related tofunded through emergency services while we are a stand-alone, all-volunteer agency. The funding will come, however, of that I am sure.
We have a community wide team where the SANEs are not hospital based. Because of this we pay them an on-call fee and pay for as much of their training as possible. Over the past three years we have received grant funding which is no longer available. We are looking for suggestions to financially sustain our SANEs. Any suggestions or ideas you can send our way would be helpful.
1.  Jen Markowitz
 If the SANEs aren't hospital-based, but they respond to hospitals to see these patients, is there the potential for the hospitals to contribute funds to support the continuation of services? I guess I'm unclear about where else expenditures are happening, though, for the SANEs: are you paying call and court pay? Do you pay for ongoing clinical education and certification? If you'd like, feel free to email me at jmarkowitz@aequitasresource.org and I'd be happy to find some time when we could talk in greater detail about the specifics of your community's challenges. And that email offer's good for anyone who would like to discuss specifics, BTW.
2.  Betty
 SANEs get paid by the state $200 for an exam. County pays for a SART Coordinator and has supplemented the on-call pay, but the program intent and wish is to have the community own it and not have it be a government program.
3.  Jen Markowitz
 It would be great to get a bit more information if possible about other sources of revenue. Is the grant your only source of funds? And does the state you're in reimburse directly to the nurses or do those monies also come to your agency?
To maintain an adequate number of SANEs in our pool, we are constantly needing to train new nurses to become SANEs. This is a very costly venture and we are wondering what credentials a person and/or organization must have in order to put on their own training? Can a SANE-A provide training to new nurses? Where would we look to find out what the requirements are to host and provide training to new nurses to become SANEs? Basically, how difficult is it to train our own nurses to be SANEs?
1.  Jen Markowitz
 In regards to whether a SANE-A can train new nurses, absolutely, as long as the person has the expertise in the field to be able to impart a well-rounded education to new SANEs. It's imperative that training is geared toward the adult learner, though, and that it encompasses to the extent possible, the clinical training that's such a big piece. If that can't include live pelvic models, than simulation can be a stand in. But I would hate to see a SANE course be 40 hours of lecture, because I don't think that's very effective. Let me know if there are other questions you have about training. I will be revisiting the forum to continue answering questions throughout the week.
2.  Jen Markowitz
 In terms of whether you have the ability to provide your own training, the short answer is yes, you probably can. I encourage you to work with IAFN, with the educational standards for SANEs published by IAFN, and with the national education standards for sexual assault forensic examiners (which can be found at www.safeta.org) to ensure the most comprehensive education program possible. It's critical that it's multidisciplinary and nursing-focused, though, so that SANEs learn the nuts and bolts of the job, but also get the role development piece that's so critical.
3.  Jen Markowitz
 Since this is a multi-part question, and I'm limited in space for each answer, I'm going to answer each part as a single response, so please check back as I post more responses to the various parts of your question. I agree, sending people to training is costly, so before deciding where you'll provide training, one of the best things I think programs can do is better screening of nurses who want to train. In the program with which I still work as a SANE, we require all prospective nurses to observe a case before training. This allows them to have a better understanding of what the role entails. I find we lose a lot of people simply because they don't understand the role--I will blame tv in part for that. (MORE)
What should SANE programs do if they only have one SANE nurse in their community?
1.  Jen Markowitz
 There are a lot of communities that have only one SANE, and the biggest mistake is to try and have that person be available around the clock. Being able to have the SANE work with the local ER to provide consistent, high quality care during the times she's not available is a critical step. Allowing her to be *a* resource and not *the* resource will probably allow communities to most benefit from the presence of a SANE, but not burn her out too quickly. And I am saying she when we talk SANEs simply for the sake of expediency, so I hope my male SANE colleagues will indulge me on this. A lot of communities feel married to the idea of 24/7 SANE coverage regardless of staffing realities, and I don't think that's realistic. But some good quality care by a SANE, and some effective collaboration between the SANE and local ED staff can still have great benefits to communities.
We have problems retaining staff, mainly due to burnout. Any suggestions?
1.  Joan Crowley
 The problem is probably less with burnout and more with compassion fatigue. Charles Figley has done a great deal of work on both defining the problem and developing strategies to cope with it. Essentially, compassion fatigue develops when a person in a helping profession is repeatedly exposed to the traumas of others. It's related to secondary PTSD. A good introduction can be found here: http://giftfromwithin.org/html/cmpfatig.html.A chart with the symptoms of CF is here: http://giftfromwithin.org/pdf/ExampleCF.pdf Organizations can reduce CF through consciously including interpersonal support in the workplace. That may be difficult to do when there are few staff working together, but the costs of changing the work environment are small compared to the cost of high turnover.
2.  Jen Markowitz
 I have some, but I'd love to hear what others think, as well, because this comes up a lot. I think as managers we could be better attuned to our staff and look more closely for those early signs of burnout that may be evident. I think exploring ways to accommodate people's needs to take care of themselves is important too--for instance in our SANE program, we've given staff 1 or 2 months off the schedule when it looked like they just needed that break. It may not be feasible to do that kind of thing in every agency, but giving folks some down time, or at least helping them access things that reenergize them, like a conference or an event with others in the field, can help. I'm not sure we do enough to directly address the issue of burnout and burnout's big sister, vicarious trauma. In the nursing world, we definitely don't spend enough time on this issue, and I'd love to see it addressed in a large-scale and meaningful way. I know there are many of you out there who've had a lot more experience with this issue, so please add your 2 cents...
3.  Rhonda Barner
 My suggestion would be to try to diversify what you do in the realm of victim services (e.g. community presentations, special projects, prevention programs, support groups, etc.) and have staff get actively involved with other victim service providers on a statewide or national level. This allow advocates to relieve some of the stress and burn out that occurs from simply doing client services. Our program is a VictimWitness Division within a County Prosecutor's Office. I have been a victim advocate for 33 years and have staff ranging from 3-25 years of service. We have a number of programs that all us to concentrate our efforts in areas that address the needs of victimssurvivors in our community but also help to keep us renewed in our commitment to the same.
For many years, the local sheriff has had the only rural Law Enforcement Victim Assistance program in the state. This spring, they tried to eliminate the program supposedly to cut the budget. An underlying cause was the unit was mismanaged and in conflict with the Sheriff. As a tenured faculty member, I could stand up and make presentations to the county commissioners about the importance of maintaining the program. The sheriff is supposedly reconstituting the unit this fall. Many of the people in the victim advocacy community were either barred from support directly (those in the cj system) or intimidated from participating by their dependence on the local power structure. How can we make it safe for people to support victim assistance in the face of political opposition?
1.  Jen Markowitz
 Wow--this is a really tough issue. I have sent your question to a couple colleagues who've had a bit more experience with this type of situation, so please check back for updates. In the meantime, I'm going to ask if anyone else has dealt with an issue like this. I'd be really interested in hearing how others have handled such a sticky political situation.
How do you retain staff members on a small budget? If we could pay our staff higher salaries, they'd be more willing stay on, but we just can't afford it!
1.  suzanne mazoff
 I am the only RC Counselor and Prevention Educator in my county in NY State. It is extremely difficult to find personnel due to financial constraints however, due to the financial climate within our country, things seem to be changing.
2.  Jen Markowitz
 I love this question, because I think it's fairly universal. Budget realities are a challenge, but we've heard great suggestions from people in the field: that people respond best when they fully understand the budget issues; when they see that everyone's in the same boat; when they are able to feel involved with some of the decision making in the organization and feel a certain ownership in the program; and when programs make an effort to find alternative ways to show appreciation for staff. Things like staff appreciation dinners at the holidays, movie tickets or a gas card to the person who had the most hours of call or fielded the most calls on the hotline or even assistance with a single conference registration in lieu of being able to provide raises can sometimes make a difference. I think it's also helpful to remember that even when we talk with programs that have relatively large budgets and pay people on the higher end of the spectrum, retention is still an issue, so satisfaction in the work and the agency is critical to keeping people on board.
Are you aware of any assessment tools that can help a program determine areas that need further development in order to sustain the program?
1.  Jen Markowitz
 I'm sure there are several out there, so I hope others will add in their suggestions, too. But the ones we've used for this project have come from a couple different sources: The Consultants Toolkit by Mel Silberman (2001 McGraw-Hill) isn't specific to victim services, but it has some fantastic tools, including assessment tools, that look at everything from collaboration to leadership. We've also used the Turning Point Collaborative Leadership assessments (there are 6), which you can find at http://www.turningpointprogram.org/Pages/pdfs/lead_dev/CL_self-assessments_lores.pdf. I'd love to hear about some of the others people have used...
The Mid-Iowa SART program is community-based. Local hospitals are on contract to allow the SANEs to come to the various hospital and perform the exam. However they do not put any financial support toward the program. We are in need of ideas for funding sustainablity. We have exhausted the local grant resources and are in the beginning stages of fundraising. Any ideas or suggestions that would help sustain this program would be welcomed.
1.  Jen Markowitz
 If it's okay with you, I'm going to come back to you on this one, because I'd like to pull some resources together that would be useful and current, but it would take more time than we have during the forum session. Please check back for updates--I will try and have something posted by the end of the week.
What are some of the common blocks to creating a sustainable assistance program?
1.  Jen Markowitz
 Well, in our work on the sustainability project, we found issues fell under 3 main categories: 1.) funding (which I think we could have all guessed); 2.) collaboration; and 3.) recruitment & retention. I don't think these are necessarily unique to SANE programs, either--the collaboration piece is a challenge for many agencies. It's impossible to provide services in a vacuum, but if the collaboration isn't healthy, service provision is that much harder. And I think it's important to be expansive about collaboration--really pushing the boundaries of who we typically consider our collaborators and forging new and creative partnerships. But above all, I think that recruitment & retention is a struggle for most agencies--there are some obvious roadblocks with recruitment/retention, but one of the things I see in my field is this idea that any warm body will do if it means the schedule gets covered. But this approach ends up costing us a lot in a variety of resources. Recruiting with greater specificity and with a clearer understanding for applicants of what the job entails is so crucial. I think we could do a better job of letting people know what the job entails and what we expect from them.
We provide psychological trauma treatment to victims. Previous to this year, grant funding had been slowly dwindling and our program was cut back. This year we received ARRA grants. Where can we go for funding to continue the program after ARRA runs out?
Are there ways we, as a domestic violence advocacy organization, pursue funding for the local clinic to train someone for SANE? We are in a rural area, and I'd like to know so that when I approach them, I can suggest it. Otherwise, it's an hour long drive or more to a SANE nurse. I assume the reason there isn't one is because of the cost of training.
1.  Jen Markowitz
 (Continued) If the clinic isn't necessarily interested in having a SANE program, perhaps pursuing funding to bring someone in to give staff a solid foundation on the medical-forensic examination might also be a good idea? The reality is that not every community will have a SANE program, but every community's healthcare facility should be able to provide competent care to sexual assault patients.
2.  Jen Markowitz
 There may be several reasons the local clinic doesn't yet have a SANE, and training could be one of them. There are also issues around being able to maintain clinical competency, and if the clinic doesn't feel as if they have the numbers to support SANE practice, that may be an issue. The cost of training itself is all over the board, from free to upwards of $1,000 in some places. Some places also pay nurses for their time and their travel expenses, but there isn't a hard and fast rule for that. Before you look for funding, I would make sure this is a service the clinic wants to provide and start working with them to lay a strong foundation for SANE practice. Also make sure that whoever is identified has a good understanding of what the role entails and feels committed to doing the work. The Virtual Practicum DVD from IAFN is one good way to give nurses exposure: http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=174 (Please see next response for more on this question)
Do you have suggestions on how to both fund and get agency approval for additional clinical staff members to work in the department on daily basis?
1.  Jen Markowitz
 I would be the most popular person in the field if I said yes to your question, wouldn't I? Sadly, this one's pretty specific to your organization in a lot of cases. What I think is true across the board is being able to illustrate the need and the benefit. I'm excited to report (and hopeful that I will be able to return within the week with an electronic link) that we have a brand new bulletin just published on Developing Business Plans for SANE Programs. It's a very common sense and simply written document that will help programs plug in economic data and relevant information so critical to crafting arguments to organizations and funders for ongoing (or initial) support. I hope that will make your quest an easier one. We will have hard copies at the IAFN Assembly, and I will also post it at the Sustainability blog: www.nsvrc.org/SANE-blog. You'll also see it posted on the NSVRC homepage and I promise to update this site with the link as soon as I have the PDF (thanks in advance for your patience!).
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